urinary

Question 1

definition of hydronephrosis

Answer 1

condition in which urine gets trapped in the kidney and drains slower than it should into the bladder. This causes the kidney to appear swollen.

Question 2

causes of hydronephrosis

Answer 2

UPJ obstruction-blockage at the point where the kidney meets the ureter
UVJ obstruction - blockage at the point where the ureter meets the bladder.
Posterior urethral valves- obstruction that occurs prior to birth in males that is caused by pieces of tissue in the area of the prostatic urethra.
Ureterocele -occurs when the ureter does not develop properly and causes a small pouch into the bladder.
Other causes can be:
Vesicoureteral reflux - urine in the bladder flows back into the ureters and often back into the kidneys.
Ectopic Ureter- drains urine somewhere outside the bladder.
Neurogenic Bladder- nerves that carry messages from the bladder to the brain and from the brain to the muscles of the bladder do not work properly.

Question 3

How is hydronephrosis diagnosed

Answer 3

prenatal ultrasounds- dilation of renal pelvis and calyxes
intravenous urography- dilation of renal pelvis and calyxes
scintagraphy

Question 4

signs and symptoms of hydronephrosis

Answer 4

abdominal pain, flank pain, hematuria, UTI

Question 5

Treatment of hydronephrosis

Answer 5

If detected prenatally, just monitor.
1. Decompress bladder with a catheter
2. Antibiotics (intravenously)
3. Renal transplantation in severe cases
4. Vesico-amniotic shunt
If severe, or child’s condition is worsening need surgery.
surgery- resection of obstructed part of ureter and anastmosis to a healthy part

Question 6

define hypospadias

Answer 6

male urethral opening is not located at the tip of the penis.Most commonly the opening is located along the underside of the penis close to the tip

Question 7

what is the cause of hypospadius

Answer 7

urethral folds dont close properly
progesterone treatment during pregnancy
defects in testosterone production

Question 8

what are the symptoms of hypospadius

Answer 8

Abnormal appearance of foreskin and penis on exam
Abnormal direction of urine stream
The end of the penis may be curved downward (chordee) and curved erection

Question 9

What is the treatment of hypospadius

Answer 9

First 4 weeks of life- clinical exam +endocrine checkup
hormonal therapy in case of micro-penis
surgery- within 2 years reconstruction of penis to straighten penis, put opening at tip of penis good direction of stream
urethroplasy or meatomy ( opening of hole) if needed

Question 10

Define epispadias

Answer 10

Abnormal opening of the urethral meatus on the dorsal face of the penis (male) or under clitoris (female)

Question 11

How do boys present with epispadias

Answer 11

Abnormal opening on top surface of penis
Backward flow of urine into the kidney (reflux nephropathy)
Short, widened penis with an abnormal curvature
large urethra
Urinary tract infections
Widened pubic bone

Question 12

How do girls present with epispadias

Answer 12

bifid clitoris and labia
Abnormal opening from the bladder neck to the area above the normal urethral opening
Backward flow of urine into the kidney (reflux nephropathy)
Urinary incontinence
Urinary tract infections

Question 13

How do you diagnose epispadias

Answer 13

pelvic xray- wide distance between midline
sterile urine
urography
retrograde cystography - assess vesico-urethral reflux
urodynamic test- incontinence

Question 14

What is the treatment of epispadias

Answer 14

Incontinence correction
• Repair of external genital organs
• Ureter reconstruction
• In girls: urethra-sphincterin reconstruction realized on a cooperating child (7-10 yo).
• In boys: dorsal incurvation of the penis has to be treated for a good sexual life.

Question 15

define cryptorchidism

Answer 15

incomplete/ partial descent of testis into scrotal sac ( testis usually form in abdomen then go down) most common is partial in inguinal area
Can be :
• complete (intra-abdominal or intra-parietal) or incomplete (upper inguinal or lower inguinal)
• contained (testicle contained in completely permeable peritoneo-vaginal canal-or intraabdminal), or testicle with a long
pediculus

Question 16

signs and symptoms of cryptorchidism

Answer 16

clinical examination:
testis non palpable
retractile - It a common finding in young boys, strong cremasteric reflex, testicles can be retracted into the inguinal canal . find the testes in the inguinal canal, or high up in the scrotum, and gently try to ‘milk’ it down into the scrotum

Question 17

Diagnosis of cryptorchidism

Answer 17

Ultrasound- localises testis
endocrine:
high fsh, high lh, normal testosterone unless both testis affected
smear test

Question 18

treatment of cryptorchidism

Answer 18

injection with lh,fsh to test for retractile testis( goes to scrotum when excited)
surgery- orchiopexy

Question 19

complications of cryptorchidism

Answer 19

testicular atrophy- infertile
when malpositioned in inguinal canal, at risk of testicular torsion, trauma
if left untreated- risk of germ cell tumours

Question 20

define acute scrotum

Answer 20

sudden onset of scrotal pain, which is accompanied by swelling,
erythema, and systemic signs of illness

Question 21

define testicular torsion

Answer 21

a twisting of the testicles and the spermatic cord > lack of blood supply to testis> ischemia

Question 22

What is the cause of testicular torsion

Answer 22

In boys: incomplete attachment of the testes within the scrotum. This permits the testes to be more movable, allowing them to twist.

in fetus: absence of epididymal and testicular fixation.development of the protective sac that surrounds the testicles within the scrotum does not attach to the scrotum internally. ( tunica vaginalis)The non-fixed testicles ascend, twists under influence of cremasteric contraction.

Question 23

clinical presentation of testicular torsion in neonates

Answer 23

big inflammatory scrotum, containing firm painless mass. The intervention by inguinal approach detects
a black testicle, a pediculus twisted by many turns to the superficial inguinal orifice.

Question 24

clinical presentation of testicular torsion in boys

Answer 24

sudden onset of severe pain
swollen, tender , red scrotum
testis go up and lie in a horizontal line

Question 25

Diagnosis of testicular torsion

Answer 25

Doppler Ultrasound Scan can be done to look at the flow of testicular blood – this helps to rule out epididymitis where the flow will be present.
testicular scintigraphy

Question 26

Treatment of testicular torsion

Answer 26

Surgical emergency
neonates- inguinal approach to treat possible hernia
boy- scrotal approach- necrotised testicle removed, fixation of other testicle

Question 27

Differential diagnosis of testicular torsion

Answer 27

infarction caused by tumour or hemmorhage in new born
Epididymitis (main differential)
Epididymo-orchitis
Scrotal oedema

Question 28

define phimosis

Answer 28

foreskin is unable to be retracted to expose the glans. This condition is a normal occurrence in newborn boys, but over time the skin that adheres to the tip of the penis can be retracted as the foreskin loosens by age 5

Question 29

what are the symptoms of phimosis

Answer 29

primary- Bulging of the foreskin during urination like balloon
secondary- recurrent infection and irritation leads to scarring
balatanitis- a pus filled infection of the foreskin.

Question 30

define paraphimosis

Answer 30

foreskin is pulled back behind the coronal groove of the penis and cannot be returned to its regular position. When the foreskin is behind the groove, blood flow to the penis is cut off.

Question 31

Causes of paraphimosis

Answer 31

no/partial circumcision
foreskin remains retracted
condition that affects smoothness- warts, infammation
after sex

Question 32

Treatment of phimosis

Answer 32

steroid cream
Preputioplasty is a surgical procedure performed to widen a tight foreskin, foreskin is kept and can be retracted
circumcision

Question 33

Treatment of paraphimosis

Answer 33

Surgical emergency
manual compression with ice to reduce swelling
, many needle punctures to squeeeze fluid out
small incision made in foreskin dorsal midline to relieve pressure

Question 34

define ambiguous genitalia

Answer 34

infant’s external genitals don’t appear to be clearly either male or female. genitals may be incompletely developed or the baby may have characteristics of both sexes

Question 35

What are the categories of ambiguous genitalia

Answer 35

sex chromosome, 46XY, 46XX

Question 36

causes of ambiguous genitalia females

Answer 36

Congenital adrenal hyperplasia. adrenal glands make excess (androgens).
Certain drugs that stimulate male hormone production.
Tumors.

Question 37

causes of ambiguous genitalia males

Answer 37

Androgen insensitivity syndrome.
Abnormalities with testes or testosterone. .
5a-reductase deficiency, impairs normal male hormone production.

Question 38

clinical features of ambiguous genitalia

Answer 38

Babies who are genetically female (with two X chromosomes) may have:

An enlarged clitoris, which may resemble a penis
Closed labia, or labia that include folds and resemble a scrotum
Lumps that feel like testes in the fused labia
Babies who are genetically male (with one X and one Y chromosome) may have:

(hypospadias)
An abnormally small penis with the urethral opening closer to the scrotum
The absence of one or both testicles in what appears to be the scrotum
Undescended testicles and an empty scrotum that has the appearance of a labia with or without a micropenis

Question 39

How to diagnose ambiguous genitalia

Answer 39

genetic karyotype 
blood, urine, hormone tests
Imaging (ultrasound renal/pelvic, 
cystogram/genitogram, 
Surgical
(cystovaginoscopy, laparoscopy, 
skin/gonadal biopsies-

Question 40

Treatment of ambiguous genitalia in females non surgical

Answer 40

genetic counselling
before birth- maternal treatment with dexamethasone
after birth- cortisol replacement
correction of fluid and electrolyte abnormalities

Question 41

Treatment of ambiguous genitalia in females surgical

Answer 41

genitoplasty- clitoroplasty, vaginoplasty

Question 42

Treatment of ambiguous genitalia in males

Answer 42

orchiectomy ( remove testicle) - due to risk of malignancy